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Excess Acetaminophen Intake, Overdosing Seen During Cold/Flu Season

During the cold/flu season, patients were more likely to relieve their symptoms with APAP-containing drugs

During the cold and flu season, researchers have reported an increased incidence of acetaminophen use and higher than recommended dosing, according to findings from a new study published in the British Journal of Clinical Pharmacology.

Acetaminophen (APAP) is a common analgesic found in numerous over-the-counter (OTC) and prescription medications indicated to relieve symptoms associated with colds, flu, allergies, and sleeplessness. When taken in excessive amounts, APAP can damage the liver.

Saul Shiffman, PhD, University of Pittsburgh, and coauthors, aimed to determine APAP use and estimate the prevalence of excess intake. Study participants were U.S. adults who used APAP in the previous 30 days sampled from various online research panels (N=14,481) between 2011 and 2016. They were asked to complete online daily medication diaries for 1 week; participants were not informed that the study concerned APAP.

The data showed 6.3% of APAP users exceeded the maximum adult daily dose (4g) on at least one day during a week they used acetaminophen, and 3.7% of the usage days exceeded the 4g limit.

During the cold/flu season, patients were more likely to relieve their symptoms with APAP-containing drugs, as evident by a significant increase in the likelihood of taking >4g APAP in a day vs the off-season: 6.5% vs 5.3% (odds ratio [OR] 1.37, 95% CI: 1.11 to 1.69). Study authors attributed this difference to increased use of OTC drug combinations intended to treat upper respiratory symptoms (33.2% of usage days in cold/flu season vs 24.8% of usage days in off-season; OR 1.6, 95% CI: 1.5 to 1.7). Removal of such medications did not demonstrate a statistically significant seasonal variation in taking APAP >4g.

"This is the first multi-year, year-round study that includes detailed data on how consumers used acetaminophen medications," said Dr. Shiffman. "Getting this message out is especially important during cold/flu season, when people may be more likely to treat illness symptoms with acetaminophen combination products, sometimes without even realizing they contain acetaminophen."